Epidemiología de las heridas por proyectil de arma de fuego en el Hospital Central Militar de México.

Introduction: Gunshot Wounds (GW) are to date a public health problem worldwide. In United States, each year from 30,000 to 50,000 people die secondary to a gunshot wound, making gunshot wounds the leading cause of death in the age group between 1-19 years of age, it is also estimated that for every death there are at least three disabling injuries resulting in approximately 150,000 injuries caused by firearm projectiles each year. In Mexico, the epidemiology of these injuries is unknown. The Military Central Hospital has no record of what could provide us some information to make it better to understand the magnitude of this problem in our environment and thereby take medical decisions best suited to the survival of our beneficiaries. Objective: To analyze the epidemiology of injuries by firearm projectile. Materials and Methods: We conducted a retrospective observational study of six years from January fist 2006 to December 31, 2011, in which 246 patients who first entered the Central Military Hospital in Mexico with a diagnosis of "Gunshot wound injury" according to their clinical record, subsequently clinical records were obtained of the Central Military Hospital archive, proceeding to the database filling with the parameters set by the researchers. Taking the patient dependent variables such as: age, sex, status in the army, hierarchy in the army (in case of being army man); were subjected to the clinical description of the injury, including anatomic site, fracture, production time between injury and admission to the emergency room and fist diagnosis, also the circumstances of injuries were described, including the place of injury, use of body armor, the caliber of the projectile and the number of impact. Variables during hospitalization were taken such as hospital days, surgical procedures, the use of hyperbaric chamber, antibiotic therapy, the number of specialties involved in the care of these patients, the use of blood transfusions, infections according to the medium culture, their complications and readmissions and the degree of disability certification for employment as military. Then, we made tables and statistical analysis of descriptive data, expressing the results in graphs and thus drawing conclusions. Results: From January the first 2006 to December 31ST 2011 we received a total of 246 patients with the diagnosis of "Gunshot wound injury" in the emergency department of the Central Military Hospital in Mexico with a total of 313 bullets, the male sex was predominant with 93% of the lesions, most patients were military (81%) and troop mainly (56%), the main circumstance in which our patients were injured by firearms was the street (56%) followed by confrontation with armed group (22%), 9 mm weapons are primarily used to produce these lesions, generating between 1 and 6 impacts per patient, mostly 2. The main affected anatomical site was lower limb, followed by chest and upper extremities, generating aggregate fractures in the 45%. While in emergency management, 16% required blood transfusion. During hospitalization most patients required one (39%) to two antibiotics (43%), being required hyperbaric chamber therapy in 5%. During follow-up, 19% of patients had a readmission for treating gunshot injuries. Conclusions: The management of these patients is a public health problem in the military population and an important issue to consider because of the large number of human and material resources for the management of these lesions resources, considering that the 246 patients were 877 performed several surgeries and that the average length of stay was 21days alert us because of the number of specialists needed to meet these demands. [ABSTRACT FROM AUTHOR]